The importance of optimal 25-hydroxyvitamin D levels in the glycemic control of older adults with type 2 Diabetes Mellitus: Data from the study on aging and longevity EELO

INTRODUCTION: Optimal serum levels of vitamin D are of great importance, especially in populations with comorbidities such as Diabetes Mellitus (DM). OBJECTIVE: The study evaluated the relationship between hypovitaminosis D and glycemic control in older adults with type 2 DM. METHODS: Cross-sectional and prospective study, part of the EELO project (Study on Aging and Longevity), conducted in Southern Brazil. Glycated hemoglobin (diabetes ≥6.5%) and serum levels of vitamin D (25(OH)D) were evaluated. Hypovitaminosis D was determined using cutoff points <20 and <30 ng/mL). Multivariate logistic regression was used to assess the risk of having uncontrolled DM. RESULTS: Of the 120 older adults included in the study, aged between 60 and 87 years, 74.2% were women, 66.7% used hypoglycemic medications and 75.8% exhibited uncontrolled diabetes. An inverse correlation was observed between the levels of 25(OH) D and glycated hemoglobin (rS=-0.19, p=0.037), suggesting that low levels of vitamin D are associated with poor glycemic control in diabetic individuals. The prevalence of hypovitaminosis D when using the cutoff points of <20 and <30 ng/mL were 34.2% and 75.0%, respectively. The odds ratio (OR) analysis showed that individuals with 25(OH)D<20ng/mL have almost 4 times more risk of having uncontrolled DM (OR:3.94; CI95%:1.25-12.46, p=0.02) when compared to the older adults with sufficient levels of vitamin D. CONCLUSION: The results indicate that the optimal serum levels currently recommended for 25(OH)D should preferably be 30 ng/mL or higher to contribute to better glycemic control in older adults with type 2 DM.

INTRODUÇÃO: Os níveis séricos ideais de vitamina D são de grande importância, especialmente na população com comorbidades como o Diabetes Mellitus (DM). OBJETIVO: O estudo avaliou a relação entre hipovitaminose D e controle glicêmico em idosos com DM tipo 2. MÉTODOS: Estudo transversal e prospectivo, parte do projeto EELO (Estudo sobre Envelhecimento e Longevidade), no Sul do Brasil. A hemoglobina glicada (diabetes ≥6,5%) e os níveis séricos de vitamina D (25(OH)D) foram avaliados. Hipovitaminose D foi determinada usando ponto de corte <20 e <30 ng/mL. Regressão logística multivariada foi utilizada para avaliar o risco de ter DM descompensado. RESULTADOS: Dos 120 idosos incluídos no estudo, idade entre 60 a 87 anos, 74,2% eram mulheres, 66,7% faziam uso de medicamentos hipoglicemiantes e 75,8% apresentavam diabetes descompensada. Uma correlação inversa foi observada entre os níveis de 25(OH)D e hemoglobina glicada (rS=-0,19; p=0.037), sugerindo que baixos níveis de vitamina D está associado a um pior controle glicêmico em diabéticos. A prevalência de hipovitaminose D quando se utiliza ponto de corte <20 e <30 ng/mL foi de 34,2% e 75,0%, respectivamente. A análise Odds ratio (OR) mostrou que indivíduos com 25(OH)D<20 ng/mL tem quase 4 vezes mais risco de ter DM descompensado (OR:3,94; IC95%:1,25­12,46; p=0,02) quando comparado aos idosos com níveis suficientes de vitamina D. CONCLUSÃO: Os resultados indicam que os níveis sérios ideais atualmente recomendados para 25(OH)D maior ou igual a 30 ng/ml contribuem para o melhor controle glicêmico na população idosa com DM tipo 2.

Decreased circulatory levels of Vitamin D in Vitiligo: a meta-analysis

Abstract Background: The serum Vitamin D status in patients with vitiligo is ambiguous when compared to controls. A systematic review and updated meta-analysis were conducted to evaluate the association between Vitamin D and vitiligo. Methods: Relevant studies were identified by searching PubMed and other databases. The random effects model was used to obtain standardized mean differences and pooled correlation coefficients. Meta-regression and sub-group analyses were conducted to explore heterogeneity. The presence of publication bias and the study robustness were tested using funnel plot and sensitivity analyses, respectively. Results: This meta-analysis finally included 31 studies. Compared with controls, vitiligo patients showed significantly decreased serum Vitamin D levels (standardized mean difference = −1.03; p < 0.0001). The sub-group analysis showed that vitiligo patients with indoor/urban work had a significantly lower Vitamin D level when compared to their outdoor/rural counterparts (standardized mean differences = −0.45; p = 0.03). The sensitivity analysis indicated that no single study had a significant influence on the overall outcome, suggesting the robustness of this meta-analysis. Study limitations: Varied sample sizes and heterogeneous study populations from different countries are the limitations of this study. However, the between-study heterogeneity has been addressed by the random-effects model with meta-regression and sensitivity analyses. Conclusions: This meta-analysis showed significantly decreased Vitamin D level in vitiligo, and its association with indoor/outdoor type of work of vitiligo patients. This study highlights the need to assess Vitamin D status for improving its level in vitiligo.

Decreased circulatory levels of Vitamin D in Vitiligo (ViViD Study): a meta-analysis

Abstract Background: The serum Vitamin D status in patients with vitiligo is ambiguous when compared to controls. A systematic review and updated meta-analysis were conducted to evaluate the association between Vitamin D and vitiligo. Methods: Relevant studies were identified by searching PubMed and other databases. The random effects model was used to obtain standardized mean differences and pooled correlation coefficients. Meta-regression and sub-group analyses were conducted to explore heterogeneity. The presence of publication bias and the study robustness were tested using funnel plot and sensitivity analyses, respectively. Results: This meta-analysis finally included 31 studies. Compared with controls, vitiligo patients showed significantly decreased serum Vitamin D levels (standardized mean difference = −1.03; p < 0.0001). The sub-group analysis showed that vitiligo patients with indoor/urban work had a significantly lower Vitamin D level when compared to their outdoor/rural counterparts (standardized mean differences = −0.45; p = 0.03). The sensitivity analysis indicated that no single study had a significant influence on the overall outcome, suggesting the robustness of this meta-analysis. Study limitations: Varied sample sizes and heterogeneous study populations from different countries are the limitations of this study. However, the between-study heterogeneity has been addressed by the random-effects model with meta-regression and sensitivity analyses. Conclusions: This meta-analysis showed significantly decreased Vitamin D level in vitiligo, and its association with indoor/outdoor type of work of vitiligo patients. This study highlights the need to assess Vitamin D status for improving its level in vitiligo.

A higher circulating concentration of 25-hydroxyvitamin-D decreases the risk of renal cell carcinoma: a case-control study

ABSTRACT Objective: To investigate the relationship between vitamin D status, using circulating 25-hydroxyvitamin D [25 (OH) D], and renal cell carcinoma (RCC) risk in a case-control study, because the association between the two is unclear in China. Materials and Methods: A total of 135 incident RCC cases were matched with 135 controls by age and sex. The blood samples were collected on the first day of hospitalization before surgery to measure plasma 25 (OH) D. Logistic regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) with adjustment for several confounders (e.g. age, gender, smoking and season of blood draw). Furthermore, the association of RCC with 25 (OH) D in units of 10 ng / mL as a continuous variable were also examined. Results: The average plasma 25 (OH) D concentrations in RCC were significantly lower compared with those of the controls (21.5 ± 7.4 ng / mL vs. 24.1 ± 6.6 ng / mL, respectively; P = 0.003). In the adjusted model, inverse associations were observed between circulating 25 (OH) D levels and RCC risk for 25 (OH) D insufficiency (20-30 ng / mL) with OR of 0.50 (95% CI: 0.29-0.88; P = 0.015) and a normal 25 (OH) D level (≥ 30 ng / mL) with OR of 0.30 (95% CI: 0.13-0.72; P = 0.007), compared with 25 (OH) D deficiency (< 20 ng / mL). Furthermore, results with 25 (OH) D as a linear variable indicated that each 10 ng / mL increment of plasma 25 (OH) D corresponded to a 12% decrease in RCC risk. Conclusions: This case-control study on a Chinese Han population supports the protective effect of a higher circulating concentration of 25 (OH) against RCC, whether the confounding factors are adjusted or not.

Analysis of the levels of serum 25-hydroxy vitamin D in autumn and winter among children of Shenmu city,Shaanxi province / 中国基层医药

Objective To investigate the levels of serum 25-hydroxy vitamin D in autumn and winter among children of Shenmu city,Shaanxi province,and to provide theoretical basis for prevention and treatment of rickets in this area.Methods From June 2016 to December 2016,a total of 277 children in the children's health clinic were sleceted.The morning fasting blood was extracted and serum levels of 25-hydroxy vitamin D were measured by enzyme-linked immunosorbent assay (ELISA).Results Among the 277 cases,there were 181 males and 96 females,including 163 infants(58.8％),75 toddlers(27.1％),24 preschool children(8.7％) and 15 school-going children(5.4％).The median (interquartile range) of serum 25-hydroxyl vitamin D was 33.21 (14.93)nmol/L.Among all children,4.3％ had severe vitamin D deficiency,15.9％ had moderate deficiency,57.0％ had mild deficiency,7.9％ had insufficient vitamin D levels,11.9％ had suitable vitamin D levels,while 2.9％ had excess of vitamin D.There was no statistically significant difference in the level of 25-hydroxyl vitamin D between different age groups(H =10.133,P ＞0.05),and different gender groups(Z =0.712,1.094,0.476,0.000,all P ＞0.05).The levels of serum 25-hydroxyl vitamin D in serum extracted in autumn were higher than those extracted in winter(75.96％ vs.90.75％,x2 =11.27,P ＜0.05).Conclusion There is significant deficiency of serum 25-hydroxyl vitamin D in Shenmu children,which significantly increased in winter.The outdoor activities should be strengthened and the vitamin D should be timely supplemented to prevent the occurrence of rickets.

Correlation between plasma 25-hydroxyvitamin D levels and the CD4+/CD8+ ratio in elderly men in different states of glucose metabolism / 中华老年医学杂志

Objective To investigate the correlation between plasma 25-hydroxyvitamin D(25-OHVD)levels and the CD4+/CD8+ ratio in elderly men in different states of glucose metabolism.Methods Clinical data of 206 elderly male patients at the geriatrics department of our hospital from April 2011 to August 2017 were collected and retrospectively analyzed.There were 85 patients with type 2 diabetes mellitus(T2DM),39 patients with impaired glucose tolerance(IGT) and 82 patients with normal glucose tolerance(NGT).Locally weighted regression and multivariate generalized linear regression models were used to analyze the correlation between plasma 25-OHVD levels and the CD4+/CD8+ ratio.Results There were significant differences in two-hour postprandial blood glucose and homeostasis model assessment of insulin resistance(HOMA-IR) between the NGT,IGT and T2DM groups (6.5 mmol/L,9.2 mmol/L vs.11.0 mmol/L,11.92 ± 10.57,16.46 ± 10.89 vs.32.67±7.39,respectively,P ＜0.01).Fasting plasma glucose and 2-hour postprandial insulin levels were higher in the IGT and T2DM groups than in the NGT group(5.1 mmol/L,6.3 mmol/L vs.4.9 mmol/L,440.5 nmol/L,367.8 nmol/L vs.255.4 nmol/L,P＜0.05).The haemoglobin A1c(HbA1c)level was higher in the T2DM group than in the NGT and IGT groups(7.1％ vs.5.5％ and 5.8％,P＜0.05).The 25-OHVD and CD4+ levels in the T2DM group were lower than those in the NGT and IGTgroups[11.6 μg/L vs.18.3 μg/L and 17.4 μg/L,(34.0±11.8)％ vs.(40.7±10.5)％ and (40.7±10.2)％,P＜0.01],but were not significantly different between the NGT and IGT groups(P ＞0.05).The CD4+/CD8+ ratios in the T2DM and IGT groups were not significantly different from each other(1.4 vs.1.6,P＞0.05),but were lower than that in the NGT group(2.7,P＜0.01).After adjusting for the influence of related confounders,CD4+/CD8+ increased by 0.4 on average with each standard deviation(7.62 μg/L)increase of 25-OHVD.Compared with 25-OHVD patients in the first quartile,CD4+/CD8+ in the second,third and fourth quartile increased by 0.7,0.9 and 1.1 respectively on average,showing a significant positive correlation and a significant linear trend in the level of 25-OHVD and the CD4+/CD8+ ratio(P＜0.01).Conclusions With the aggravation of glucose tolerance,plasma 25-OHVD levels and the CD4+/CD8+ ratio decrease by varying degrees in elderly men.The deficiency of plasma 25-OHVD may be an independent risk factor for a low CD4+ /CD8+ ratio.

Determination of 25-Dydroxyvitamin D2 and 25-Hydroxyvitamin D3 in Dried Blood Spots Using Liquid Chromatography- Tandem Mass Spectrometry / 分析化学

A high-throughput method is established to determine 25-hydroxyvitamin D2[25(OH)D2] and 25-hydroxyvitamin D3 [ 25(OH)D3 ] in dried blood spots ( DBS ) by liquid chromatography-tandem mass spectrometry ( LC-MS/MS) , which only needs a DBS sample prepared from about 6 μL of whole blood. The DBS sample processing includes ultrasonic extraction of analytes, addition of 25(OH)D2-D6 and 25(OH)D3-D3 as internal standard, application of 4-phenyl-1, 2, 4-triazoline-3, 5-dione ( PTAD ) as derivatization reagent. The procedure is carried out in a 96-well plate format in an automated liquid handling platform to facilitate high-throughput analysis. The processed sample is separated in a C18 column with water-methanol gradient elution, and quantitated by mass spectrometry in multiple reaction monitoring ( MRM) mode. For both 25(OH)D2 and 25(OH)D3, the linear range of quantitation is 0. 94-120 ng/mL, the limit of detection is 0 . 12 ng/mL ( S/N=3 ) , and the limit of quantitation is 0 . 94 ng/mL ( S/N=10 ) . The intra-day relative standard deviation ( RSD) values of 25(OH)D2 and 25(OH)D3 are 1. 4% -6. 6%, 3. 7% -7. 0%, respectively. The inter-day RSD values of 25(OH)D2 and 25(OH)D3 are 4. 0%-5. 3%, 3. 8-10. 6%, respectively. The recovery (mean±SD) in 5 consecutive of 25(OH)D2 is 98. 7%±4. 6%-108. 5%±6. 5%, and that of 25(OH)D3 is 94. 8%±6. 8%-101. 3%±2. 9%. DBS sample stability is confirmed by measuring identical DBS samples stored for 0 , 1 , 2 , 3 , 5 , 7 and 14 days at -20℃, 22℃, and 37℃, and an overall RSD°15% was observed under each temperature. DBS sample stability in freeze-thaw cycles is also confirmed by experimenting identical DBS samples up to 14 free-thaw cycles ( each cycle consisting of 23 h freezing at-80℃ followed by 1 h thaw at room temperature), and an overall RSD°15% is observed. The accuracy of 25(OH)D2 and 25(OH)D3 quantitation is validated by measuring a DBS sample prepared from NIST reference material SRM972 a Level 3 and the recovery is found to be 110 . 3% and 103 . 0%.

Detection bias evaluation of ten commercial total 25-hydroxyvitamin D immunoassays / 中华检验医学杂志

Obejective To evaluate the accuracies of ten commercial total 25-hydroxyvitamin D [25(OH) D] immnoassays.Methods NIST 25 (OH) D reference material SRM 972a,which consisted of four vials of frozen serum with different concentration levels of different 25 (OH) D types,and two human serumsamples provided by our lab (BIMT),which had different concentration levels of 25 (OH) D3,were analyzed by ten total 25-hydroxyvitamin D immnoassays from Biomerieux,Mindray,Maccura,Chemclin,Abbott (2),Siemens,SNIBE (2),Roche,and by isotope-dilution liquid chromatography-tandem mass spectrometry(ID-LC/MS/MS) founded by BIMT.For the measurements of SRM 972a,the biases between tested values and certified values were calculated as a evaluating indicator,meanwhile the test biases between immnoassays and ID-LC/MS/MS were used as a evaluating indicator for the measurements of BIMT 25(OH) D3 serum samples.Test bias lower than 10％ was deemed acceptible.Results The ID-LC/MS/MS exhibited low biases at (1.6％-2.8％) in the measurements of all levels of SRM 972a.8 immnoassays showed low biases at(1.5％-3.5％) in the measurements of level 1 of SRM 972a,which had a high 25(OH) D3 concentration level,but only 2 immnoassays gave low biases at (3.6％-3.7％)in the measurements of high 25 (OH)D2 concentration sample (level 3).While,5 immnoassays gave low biases at (-0.3％-9.0％) in the measurements of high 3-epi-25 (OH) D3 concentrationsample (level 4).It seems that,when SRM 972a were analyzed,only one of the ten commercial total 25 (OH)D immnoassays were in good accuracy and analytical specificity agrements with ID-LC/MS/MS.When two human serum25(OH) D3samples from BIMT were tested,most immunoassays were overall in relative good agreement with ID-LC/MS/MS at high 25 (OH) D3concentration level.Conclusion The test biases in the total 25 (OH) D measurements are differences between differentimmnoassays and ID-LC/MS/MS,and the specificities of current commercial total 25 (OH) D immnoassays should be improved,especially the performance on the equivalent recognition of 25 (OH) D2 and 25 (OH) D3.

Are Serum Vitamin D Levels Associated With Dry Eye Disease? Results From the Study Group for Environmental Eye Disease / 예방의학회지

OBJECTIVES: Dry eye disease (DED) is an increasingly important public health problem in Korea. Previous studies conducted in Korea have reported inconsistent results regarding the protective effects of vitamin D on DED, and these discrepancies may be related to the relatively simple questionnaire that has been used. Thus, we evaluated the association of serum vitamin D levels with DED using the ocular surface disease index (OSDI). METHODS: The present study evaluated data from participants in the Study Group for Environmental Eye Disease (2014-2015). This group included data from 752 participants, and data from 740 participants (253 men and 487 women) were analyzed in the present study. DED severity was evaluated using the OSDI. RESULTS: Higher serum vitamin D levels were associated with a non-significantly reduced risk of DED in the crude analysis (odds ratio [OR], 0.991; 95% confidence interval [CI], 0.971 to 1.011) and in the adjusted analysis (OR, 0.988; 95% CI, 0.966 to 1.010). In the crude analysis of no/mild DED vs. moderate/severe DED, men exhibited a decreased risk with increasing serum vitamin D levels (OR, 0.999; 95% CI, 0.950 to 1.051), while women exhibited an increased risk (OR, 1.003; 95% CI, 0.979 to 1.027). In these analyses, we found no significant associations. CONCLUSIONS: The findings of the present study support previous reports that serum vitamin D levels are not associated with DED.

Detection of serum levels of vitamin D and matrix metalloproteinase 9 in patients with chronic spontaneous urticaria / 中华皮肤科杂志

Objective To detect serum levels of 25 ? hydroxyvitamin D (25 [OH] D) and matrix metalloproteinase 9(MMP?9)in patients with chronic spontaneous urticaria(CSU), and to explore their significance. Methods Totally, 56 patients with CSU and 25 healthy controls were enrolled into this study. High?performance liquid chromatography tandem?mass spectrometry(LC?MS/MS)and enzyme?linked immunosorbent assay(ELISA) were performed to measure serum levels of 25(OH)D and MMP?9 respectively in these subjects. Statistical analysis was carried out by two independent samples t?test or Wilcoxon rank sum test for comparisons of the above indexes between the two groups, and by Spearman rank correlation analysis for assessment of relationships between the serum levels of 25(OH)D and MMP?9 as well as between the two indexes and disease severity. Results Of the 56 patients, 19 were diagnosed with mild CSU, 26 with moderate CSU and 11 with severe CSU. Compared with the control group, the patient group showed significantly lower serum levels of 25(OH)D(21.74 ± 6.04 vs. 30.17 ± 2.21μg/L, P0.05);the serum level of MMP?9 was positively correlated with the severity of CSU(rs=0.27, P<0.05). Conclusion Vitamin D and MMP?9 may play a role in the occurrence of CSU.

Analysis of correlation between serum 25-hydroxyvitamin D level and nonalcoholic fatty liver disease / 临床肝胆病杂志

ObjectiveTo analyze the correlation between serum 25-hydroxyvitamin D level and nonalcoholic fatty liver disease (NAFLD), and to provide a clinical basis for the prevention and treatment of NAFLD. MethodsFrom March to October, 2014, 200 Uyghur patients and 200 Han patients with NAFLD in our hospital were enrolled into NAFLD group, while an equal number of healthy Uyghurs and Hans were used as controls. For all subjects, questionnaire survey, physical examination, abdominal ultrasound examination, and blood biochemical examination were performed, and serum 25-hydroxyvitamin D level was determined using enzyme-linked immunosorbent assay. The relationship between 25-hydroxyvitamin D and NAFLD was analyzed by Spearman correlation analysis and multivariate logistic regression analysis. ResultsSerum 25-hydroxyvitamin D levels in the NAFLD group were significantly lower than those in the control group for both Uyghurs and Hans (P＜0.05), and serum 25-hydroxyvitamin D level was negatively correlated with NAFLD (rHan=-0.212, rUyghur=-0.220, P＜0.01). The results of multivariate logistic regression analysis showed that the rising serum 25-hydroxyvitamin D level was a protective factor for NAFLD (ORHan=0.894, PHan=0.015; ORUyghur=0.897, PUyghur=0.025). ConclusionSerum 25-hydroxyvitamin D level is closely associated with NAFLD in Uyghurs and Hans.

Vitamin D Receptor Poly(A) Microsatellite Polymorphism and 25-Hydroxyvitamin D Serum Levels: Association with Susceptibility to Breast Cancer / 한국유방암학회지

PURPOSE: According to previous studies, vitamin D exhibits protective effects against breast cancer via the vitamin D receptor (VDR). There is growing evidence that breast cancer incidence is associated with various polymorphisms of the VDR gene. This study investigates the association of VDR poly(A) microsatellite variants with 25-hydroxyvitamin D (25(OH)D) serum levels and breast cancer risk. METHODS: Polymorphism analysis was performed on a total of 261 blood samples, which were collected from 134 women with breast cancer and 127 controls. Single strand conformation polymorphism was assessed by polymerase chain reaction in combination with sequencing to detect poly(A) lengths for each sample. The vitamin D levels of samples were determined by electrochemiluminescence. RESULTS: The poly(A) variant L allele frequency was significantly higher in cancer patients than in controls (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.16-2.57; p=0.006). Thus, carriers of the L allele (LS and LL genotypes) have a higher risk for breast cancer (OR, 1.86; 95% CI, 1.13-3.05; p=0.013). A larger increase in the risk for breast cancer was found in individuals with the L carrier genotype and lowered 25(OH)D levels. CONCLUSION: The results primarily suggest that VDR gene polymorphism in the poly(A) microsatellite is associated with 25(OH)D levels and that it can affect the breast cancer risk in the female population from northern Iran.

Interaction of Vitamin D and Smoking on Inflammatory Markers in the Urban Elderly / 예방의학회지

OBJECTIVES: Epidemiological studies have reported that vitamin D deficiency is associated with inflammatory disease. Smoking is a well-known risk factor for inflammation. However, few studies have investigated the interactive effect of vitamin D deficiency and smoking on inflammation. This study aims to investigate the interaction of vitamin D and smoking with inflammatory markers in the urban elderly. METHODS: We used data from the Korean Elderly Environmental Panel Study, which began in August 2008 and ended in August 2010, and included 560 Koreans > or =60 years old living in Seoul. Data was collected via questionnaires that included items about smoking status at the first visit. Vitamin D levels, high-sensitivity C-reactive protein (hs-CRP), and white blood cell (WBC) counts were repeatedly measured up to three times. RESULTS: The association of vitamin D and hs-CRP was significant after adjusting for known confounders (beta=-0.080, p=0.041). After separate analysis by smoking status, the association of vitamin D deficiency and hs-CRP in smokers was stronger than that in nonsmokers (smokers: beta=-0.375, p=0.013; non-smokers: beta=-0.060, p=0.150). Smoking status was an effect modifier that changed the association between vitamin D deficiency and hs-CRP (interaction estimate: beta=-0.254, p=0.032). Vitamin D was not significantly associated with WBC count (beta=0.003, p=0.805). CONCLUSIONS: Vitamin D deficiency was associated with hs-CRP in the urban elderly. Smoking status was an effect modifier of this association. Vitamin D deficiency was not significantly associated with WBC count.

Comparison of five automated 25OHD immunoassays and liquid chromatography tandem mass spectrometry method / 中华检验医学杂志

Objective To compare the concordance of five automated 25OHD immunoassays with liquid chromatography tandem mass spectrometry method ( LC-MS/MS) .Methods During May to July in 2014, 245 clinical serum samples that requested 25OHD tests were selected, with a total 25OHD range of 2.8 ng/ml-64.0 ng/ml, in which 154 samples did not contain 25OHD2 and 91 samples contains both 25OHD2 and 25OHD3 .To used a LC-MS/MS method that built in our laboratory to measure 25OHD, five commercial automated chemiluminescent immunoassays from Abbott Diagnostics ( A ) , DiaSorin LIASON (B), IDS-iSYS(C), Roche Diagnostics(D), and Siemens ADVIA Centaur(E).Taking the reference method LC-MS/MS as a standard , to compared the concordance and performance of the five automated 25OHD immunoassays.And used the commonly accepted cutoffs for 25OHDdeficiency (<20 ng/ml), and insufficiency ( 20 -30 ng/ml ) , and sufficiency (≥30 ng/ml ) to compare the uniformity of different methods .Statistical analysiswere performed by MedCalc software , Passing & Bablok regression , Bland &Altaman plots and Box and whisker plots were performed to compare the differences of the methods .Results The medium ( range:2.5% -97.5%) 25OHD of the 245 serum samples of the six methods was 23.5 (5.8-44.2) ng/ml(LC-MS/MS),20.6 (7.1-43.5)ng/ml(A),19.0 (5.4-38.0) ng/mL (B),23.0 (10.0-38.1) ng/ml(C),20.1 (5.1 -46.0) ng/ml (D),31.3 (12.3 -71.1) ng/ml (E), respectively .Passing and Bablok regression showed that method B had the best correlation coefficient with LC-MS/MS (r=0.894), while methods A, C and D had relatively small bias compared withLC-MS/MS and method E had the large bias .If the serum samples did not contain 25OHD2 , all the five automated immunoassays correlated well with LC-MS/MS with a correlation coefficient higher than 0.84, and B has the best correlation with LC-MS/MS ( r=0.930 ) .While all the correlation coefficient between immunoassays and LC-MS/MS decreasedwhen analyzing the samplescontaining 25OHD2.Using the clinical cutoffs, A, B, C, D and E had a concordance of 68.6%, 64.9%, 67.8%, 70.6% and 51.8% compared with LC-MS/MS, respectively .Conclusions There are significant differences between different detection systems of 25OHD.All the immunoassays results were affected by the existence of 25OHD2 .The concordance of serum 25OHD resultswas poor between different methods , and it may be necessary to built exclusive cutoffs for different methods.

Efeito de doses elevadas de vitamina D3 associada à suplementação de cálcio em modelo experimental de nefrolitíase / Effect of vitamin D3 overdose and calcium supplementation in experimental nephrolithiasis model

Introdução: Há poucos dados na literatura sobre a suplementação de vitamina D e cálcio e o desenvolvimento de cálculos renais. Objetivo: Avaliar o efeito de doses elevadas de vitamina D3 (V), com suplemento de cálcio (Ca) no desenvolvimento de litíase em modelo experimental. Métodos: Pastilhas foram inseridas na bexiga de ratos, que receberam V com ou sem Ca. Ratos foram divididos em seis grupos: 1. Sham; 2. Controle com pastilha, 3. Controle com V, 4. Pastilha + V, 5. Pastilha + Ca e 6. Pastilha + Ca + V. Resultados: Observou-se 50% e 17% de redução na formação de cálculos, respectivamente nos grupos 5 e 6 em comparação ao grupo 2 (p < 0,005). Não foram observadas hipercalcemia ou hipercalciúria em todos os grupos. Encontramos no grupo 6 (p = 0,03) uma redução significativa na calciúria. Conclusão: A administração de V associada com Ca diminuiu significantemente a formação de cálculos e reduziu significantemente a calciúria, sugerindo uma interferência benéfica na fisiopatologia litogênica. .

Introduction: There is little information in the literature relating supplementary oral usage of vitamin D and calcium to the development of kidney stones. Objective: To evaluate the effect of high dose, 200 IU of vitamin D3 (V) with calcium supplementation (Ca). Methods: Experimental model consists of insertion of pellets into the bladder of rats. V was administered for 30 days with or without Ca. The rats were divided in 6 groups: 1. Sham, 2. Pellets control; 3. V control; 4. Pellets + V; 5. Pellets + Ca and 6. Pellets + Ca + V. Results: 50% and 17% decreases bladder stones formation in groups 5 and 6, p < 0.005 comparing with the group 2 were observed. There was no hypercalcemia or hypercalciuria in all groups. We observed a significant decrease in calciuria in group 6 (p = 0.03). Conclusion: The administration of the V associated with Ca significantly decreased the formation of stones and caused a significant reduction in urinary calcium, suggesting a protection in the lithogenic pathophysiology. .

Vitamin D and Kidney disease: what we know and what we do not know / Vitamina D e doença renal: o que nós sabemos e o que nós não sabemos

Vitamin D deficiency is common in the chronic kidney disease (CKD) population. CKD has been recognized as a significant public health problem and CKD patients are at increased risk of total and cardiovascular morbidity and mortality. There are increasing epidemiological data suggesting that vitamin D deficiency may play a role in overall morbidity and mortality associated with CKD. The vitamin D hormonal system is classically implicated in the regulation of calcium homeostasis and bone metabolism but there is ample evidence to support the claim that extra renal conversion of 25(OH)D to 1.25(OH)2 has significant biological roles beyond those traditionally ascribed to vitamin D. Based on the current state of evidence this review intends to give an update on novel biological and clinical insights with relevance to the steroid hormone vitamin D specifically in patients with kidney disease.

A deficiência de vitamina D é um achado comum em pacientes com doença renal crônica (DRC). A DRC é reconhecida como um problema de saúde pública importante, com elevado risco de morbimortalidade total e cardiovascular. Inúmeras publicações epidemiológicas sugerem que a morbimortalidade nesses pacientes pode estar associada à deficiência de vitamina D. O sistema hormonal da vitamina D é classicamente implicado na regulação do metabolismo ósseo e da homeostase do cálcio; entretanto, há uma grande evidência de que a conversão de 25(OH)D para 1.25(OH)2 tem um papel biológico significante além daquele tradicionalmente descrito. Baseada em atual evidência, esta revisão pretende ressaltar os aspectos clínicos e biológicos relevantes no sistema hormonal da vitamina D especificamente em pacientes com doença renal.

Hipercalcemia e lesão renal aguda causadas por abuso de um composto veterinário parenteral contendo vitaminas A, D e E / Hypercalcemia and acute kidney injury caused by abuse of a parenteral veterinary compound containing vitamins A, D, and E

Um rapaz de 19 anos, previamente hígido, procurou o hospital com queixas de anorexia, náuseas e vômitos. Exames laboratoriais revelaram hipercalcemia (valor máximo do cálcio de 14,8 mg/dL) e lesão renal aguda (valor máximo da creatinina de 2,88 mg/dL). O paciente admitiu utilizar uma formulação parenteral de vitaminas A, D e E de uso exclusivo veterinário, contendo 20.000.000 UI de vitamina A; 5.000.000 UI de vitamina D3 e 6.800 UI de vitamina E, por ampola de 100 mL. Ele refere ter usado cerca de 300 mL do produto no último ano. O jovem não estava interessado na quantidade maciça de vitaminas contida no produto, mas apenas no efeito local do veículo oleoso; o edema provocado pela injeção simulava um aumento de massa muscular. O produto, no entanto, foi absorvido e causou hipervitaminose. O nível sérico de 25(OH) vitamina D estava claramente elevado em 150 ng/mL (referência de 30 a 60 ng/mL), mas não tanto quanto em outros casos publicados de intoxicação por vitamina D. A maioria dos casos de hipercalcemia por hipervitaminose D se associa a níveis de 25 (OH)D bem maiores do que 200 ng/mL. O PTH estava indetectável, e outras causas de hipercalcemia foram excluídas. Deste modo, conclui-se que a gravidade da hipercalcemia encontrada neste caso foi resultado do efeito sinérgico da intoxicação pelas vitaminas A e D. O paciente foi tratado com soro fisiológico, furosemida e ácido zolendrônico e evoluiu com normalização rápida dos níveis séricos de cálcio e da função renal.

A previously healthy 19 year-old male presented to the hospital with anorexia, nausea, and vomiting. Laboratory studies were significant for hypercalcemia (peak calcium value of 14.8 mg/dL) and acute kidney injury (peak serum creatinine of 2.88 mg/dL). He admitted to using a parenteral formulation of vitamins A, D and E restricted for veterinary use containing 20,000,000 IU of vitamin A; 5,000,000 IU of vitamin D3; and 6,800 IU of vitamin E per 100 mL vial. The patient stated to have used close to 300 mL of the product over the preceding year. Interestingly, the young man was not interested in the massive amounts of vitamins that the product contained; he was only after the local effects of the oily vehicle. The swelling produced by the injection resulted in a silicone-like effect, which gave the impression of bigger muscles. Nevertheless, the product was absorbed and caused hypervitaminosis. The serum level of 25(OH) vitamin D was clearly elevated at 150 ng/mL (reference range from 30 to 60 ng/mL), but in most published cases of vitamin D toxicity, serum levels have been well above 200 ng/mL. His PTH level was undetectable and other potential causes of hypercalcemia were excluded. Therefore, we posit that the severity of the hypercalcemia observed in this case was the result of a synergistic effect of vitamins A and D. The patient was treated with normal saline, furosemide and zolendronic acid, with rapid normalization of calcium levels and renal function.

25-Hydroxyvitamin D Status in Patients with Chronic Kidney Disease in a Single Center / 대한신장학회지

PURPOSE: We checked the levels of serum 25-hydroxyvitmain D (25OHD) in the patients with chronic kidney disease (CKD) to survey the status of vitamin D levels, to see the seasonal variations of 25OHD, and to evaluate the relationships among the levels of intact PTH, corrected calcium, and phosphorus. METHODS: We defined vitamin D insufficiency and vitamin D deficiency as serum 25-hydroxyvitamin D levels between 20 and 30 ng/mL and below 20 ng/mL, respectively. 185 patients in a single center were enlisted who categorized into 3 groups, CKD2-3, CKD4, and CKD5 by eGFR using MDRD7 equation. To see the seasonal differences of the levels of 25OHD, we collected laboratory data two times per each patient during summer division (April to September) and winter division (October to March). RESULTS: Prevalences of hypovitaminosis D were 42.8% (CKD2-3), 66.1% (CKD4), 92.8% (CKD5) in summer division and 48.7% (CKD2-3), 73.1% (CKD4), 92.8% (CKD5) in winter division. Seasonal difference of the levels of 25OHD was evident only in CKD stage 2-3 (p=0.018). Negative correlations were recognized between 25OHD and intact PTH (r=-0.2048, p<0.001), phosphorus (r=-0.1711, p=0.0011). CONCLUSION: Hypovitaminosis D is prevalent even in patients with early stages of CKD. The levels of 25OHD decreased significantly in winter division in patients with CKD stages 2-3. The levels of 25OHD were inversely correlated with those of intact PTH, phosphorus, respectively.